Booking visit Flashcards
When is this ideally done?
At or before 10 weeks gestation
Confirmation of pregnancy
+ve urine pregnancy test + symptoms of pregnancy = confirmation
Dating scan to be offered to all women between 10-14 weeks
At what ages are women more at risk of obstetric complications?
<17 and >35
PMH - women needing additional care
HTN DM (GDM more common if first degree relative = diabetic) BMI>30 Age>40 and teenagers Psychiatric disorders Smoker Epilepsy Recreational drug use Thromboembolitic disease
Obstetric HX - women needing additional care
Recurrent miscarriage (x3) Grand multip (>6 children) Previous preterm birth Still birth/neonatal death Pre-eclampsia C-section Pueperal psychosis Baby with congenital abnormalities Baby <2.5kg or >4.5kg
Gynae Hx
Sub-fertility - increases peri-natal risk
Assisted pregnancy - higher chance of multiple pregnancy
Uterine surgery - probably deliver c-section
Cervical smear - rearrange for 12 weeks postpartum if due during pregnnacy
Social Hx
Smoking/alcohol
Married/single/support at home
Employment - break for history
Housing, finance, domestic abuse - everything OK at home?
Examination
General health + nutritional status
BMI calculated (>30 = higher risk)
Baseline BP
Abdominal examination - uterus palpable at 12 weeks
Routine blood tests
FBC and screen (anaemia, thombocytopenia, sickle cell, thalassemias)
Blood group and Rh status (Rh -ve - anti-D given at 28 weeks and within 72 hours of delivery)
HIV - need to use antiretrovirals throughout pregnancy and up to 6 weeks for the newborn + CS + increased risk of pre-clampsia, IUGR and stillbirth
Hepatitis B - notifiable disease, 90% of infected neonates become chronic carriers, neonatal immunisation
Syphilis - usually results in miscarriage, stillbrith or serious congenital malformations
Prompt treatment with benylpenecillin + GUM referral
Mother must recieve treatment > 4 weeks before delivery, otherwise newborn requires IV
Non-routine screening tests
Chlamydia and Gonorrhoea (women <25 encouraged)
TC - neontal conjunctivitis (30%), neonatal pneumonia (15%)
NG - postparetum endometritis, chorioamnionitis, neontal opthalmia (40%)
Hep C - Hx of drug abuse/obstetric cholestasis
Group B strep
BV
Non-routine urinalysis
Urine microscopy - MSU to check for asymptomatic bacteruria (can lead to pyelonephritis in 20%)
Urinalysis - glucose, protein, nitrites - DM, renal disease, UTI
Health promotion and advice - drugs
Folic acid - 400mcg/day until 12 weeks
Vit D - 10ug/day (BMI>30, south asian or afro-caribbean)
Iron supplements if:
Hb <110 in first trimester, <105 2nd trimester, <100 3rd trimester
DO NOT TAKE VIT A
Anti-epileptics - carbamzapine and Lamotrigine are safest during pregnancy
When should 5mg folic acid be prescribed?
Hx of neural tube defects (woman and partner), DM or on an antiepileptic
Health promotion - lifestyle
Diet - well balanced ~2500 calories a day
Avoid alcohol and smoking (nicotine replacement)
Infection avoidance - drink pasturised milk to avoid listeriosis
Avoid soft or blue cheese, pate and uncooked/partially uncooked food
Antenatal planning - pre-eclampsia
More common in nulliparous women and 15x more common in women with previous Hx
Low dose aspirin given to those at risk (75mg)
Previous C-section
Those who had C-section for non-recurrent reasons (breech, foetal distress etc.) may be offered a trial of vaginal delivery
NICE guidelines do not recommend vaginal delivery after 3 previous CS
Smokers
Increased risk of SGA - foetal hypoxia and ischemia due to higher levels of CO and nicotine
All smoking mothers offered CO blood level reading
Pregnancies at risk of IUGR, SGA, placental abruption, preterm labour, stillbirth and SIDS
Anemia
Increased blood volume (40%) –> reduction in Hb
Offered iron supplemantaiton if:
Hb <110 in 1st, <105 in 2nd, <100 in 3rd
or if MCV <80
Gestational DM
All women offered glucose tolerance test at 26 weeks or 16 weeks if: BMI>30 Previous GDM 1st degree relative with DM South Asian or Afro-carribbean Previous baby's weight >4.5kg
